Urethral Stricture (cont.)

Siamak N. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What is the treatment for urethral stricture?

There are essentially no real medical treatments (medications) for urethral strictures other than that offering symptom control (for example, pain medications to control discomfort). Surgery remains the only treatment for individuals with uncontrolled symptoms of urethral narrowing.

Increasing post-void residual (amount of urine left in bladder after urination)

Failure of conservative measures to control symptoms (pain)

What surgical options are available for urethral stricture?

Many surgical procedures are available for treating urethral strictures. Depending on the cause and other medical and social aspects, the most appropriate procedure may be recommended for each individual case. The common procedures include

urethral dilation,

urethrostomy,

urethral stent placement,

open urethral reconstruction.

Urethral dilation is a commonly attempted technique for treating urethral strictures. This procedure is done under local or general anesthesia. Thin rods of increasing diameters are gently inserted into the urethra from the tip of the penis (meatus) in order to open up the urethral narrowing without causing any further injury to the urethra. This procedure may need to be repeated from time to time, as strictures may recur. The shorter the stricture, the less likely it is to recur after a dilation procedure. Occasionally, patients are given instructions and dilation instruments (rods, lubricating gel, and anesthetic gel) to perform the urethral dilation at home as needed.

Urethrostomy (or internal urethrostomy) is an endoscopic procedure that is typically done under general anesthesia. A thin tube with a camera (endoscope) is inserted into the urethra to visualize the stricture (as describe in earlier section). Then a tiny knife is passed through the endoscope to cut the stricture lengthwise and open the flow of urine. A Foley catheter (urinary catheter) is then inserted and kept in place for a few days while the urethral incision is healing. The success rate of this procedure is about 25%, and again, shorter strictures generally have a better response to this procedure.

Urethral stent placement is another endoscopic procedure aimed at treating urethral strictures. Depending on the location of the stricture in the urethra, a closed tube (stent) can be passed through an endoscope to the area of the stricture. Once it reaches the proper location, then the stent can be opened to form a patent tube or conduit for urine to flow.

Open reconstruction entails several possible techniques for correction of urethral strictures. These are surgeries that involve opening the urethra surgically under general anesthesia to fix the stricture. In some, the area of scarring is cut out and the remaining urethra is reconnected. In others, after the scar tissue is removed, a graft from inside the cheek (buccal mucosa) or a skin flap may be used to form a reconstructed urethra. These techniques in general have a good response rate, although they are more invasive than other described procedures.

The treating urologist would recommend the procedure that would be the best option for each individual. As with any medical procedures, there is some degree of risks and complications associated with any of these operations.